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실험연구 : 전자회로기판 히터를 이용한 고열효율 휴대용 수액 혈액 가온기의 유속에 따른 가온능력 및 안정성 평가
정성원 ( Sung Won Jung ),한태형 ( Tae Hyung Han ),이진영 ( Jin Young Lee ),곽인숙 ( In Suk Kwak ),정미화 ( Mi Hwa Jung ),원임수 ( Rim Soo Won ),최영룡 ( Young Ryong Choi ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: Currently available warming devices are often heavy and cumbersome, requiring development of more portable, user friendly, high efficiency fluid and blood warmer. The intravenous fluid heating capabilities of a new, heat-plate print circuit board (PCB) based warmer at various low flow rates were tested. Methods: Model Joyother BM-1® was investigated for normal saline (0.9% NaCl) and colloid at various infusion rates (60-6000 ml/hr). Final temperatures were measured by electronic thermometer after passing through the warmer. Effective warming was defined as a fluid temperature ≥ 32℃. Ambient temperature was maintained at 22-25℃. Degree of heating capability and temperature decrease were compared and correlated between different flow rates. Results: The device warmed the room temperature crystalloid and colloid efficiently. Its warming capability was continuously improved as the flow rates increased in all tested flow rates, reaching maximum 41℃. After the warming, the temperature decrease showed high negative correlation with the flow rates. The extent of cooling was less in colloid. No overheating was noted at sudden brake. Conclusions: Joyother BM-1® heated crystalloid and colloid sufficiently and safely enough for clinical application (exit temperature ≥ 35℃) at various flow rates. The warming capacity and the length of the intravenous tube infusion system determined the efficiency of the warmer. Further study is warranted for the efficiency of warming for the blood and its element changes. (Korean J Anesthesiol 2006; 51: 598~605)
문창수,조병욱,이용찬,송영완,원임수,Moon, Chang-Soo,Cho, Byoung-Ouck,Lee, Yong-Chan,Song, Young-Wan,Won, Rim-Soo 대한악안면성형재건외과학회 1993 Maxillofacial Plastic Reconstructive Surgery Vol.15 No.4
The trauma has been known as a major etiologic factor in temporomadibular joint disorders. The endotracheal intubation is suspected as one of the traumatic factor to temporomandibular disorder. But there are few reports about the amount of mouth opening during endotracheal intubation and temporomandibular joint disorder after endotracheal intubation. The authors studied the effects of endotracheal intubation to temporomandibular joint with 70 patients given surgical operation through general anesthesia. The results were as follows. 1. The mean amount of mouth opening for entire patients during endotracheal intubation was 26.3mm (s, d : 2.6), for oral intubation group 25.9mm(s, d : 3.2), for nasal intubation group 26.6mm(s, d : 1.9). There was no difference between two group stastically. (p<0.05) 2. 1 week later endotracheal intubation, the maximum mouth opening increased 1.5mm for entire patients, 1.5mm for oral intubation group, 1.6mm for nasal intubation group than behare endotracheal intubation. 3. Five patients complained the discomforts around temporomandibular joint after endotracheal intubation. The amount of mouth opening during endotracheal intubation was within physiologic range. It seemed that $45^{\circ}$ upward endoscopic lifting for exposure of glottis gave trauma to temporomandibular joint.
곽인숙 ( In Suk Kwak ),정성원 ( Sung Won Jung ),이진영 ( Jin Young Lee ),정미화 ( Mi Hwa Jung ),최영룡 ( Young Ryong Choi ),원임수 ( Rim Soo Won ),한태형 ( Tae Hyung Han ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: Major burns can alter the pharmacokinetics of the commonly used drugs during the perioperative period. This study was carried out to define the pharmacokinetics of propofol in the burned patients during the subacute hyperdynamic phase of the injury. Methods: Twenty adults, aged 43.7 ± 2.3 years, with total body surface area burn of 44.0 ± 22.2%, were examined at 14.1 ± 2 days after the injury (mean ± SD). Age and sex gender matched unburned patients were used as controls. Propofol 2 mg/kg was given intravenously over 10 seconds as a single bolus in both groups. Blood samples (n = 20) were collectedat predetermined intervals. A noncompartmental approach was used for the pharmacokinetic analyses of the propofol concentrations, which were determined by HPLC. The cardiac index was measured by esophageal echocardiography. Results: The burns patients had a significantly higher cardiac index (CI). The clearance (CI) and total volume of distribution (Vd) of propofol were higher in the burns patients, compared with the controls, yielding a smaller area under the curve. The total half-life (t1/2) was similar in both groups. Conclusions: There is a large increase in Vd and CI in the burns patients compared to with the controls. The increased Cl in the burns patients is most likely to be related to the increased CI. Therefore, the initial bolus dose and maintenance infusion may have to be increased in the burns patients, provided the pharmacodynamic sensitivity is unaltered. (Korean J Anesthesiol 2006; 51: 285~91)
조병옥(Byoung Ouck Cho),이용찬(Yong Chan Lee),문창수(Chang Soo Moon),송영환(Young Wan Song),원임수(Rim Soo Won) 대한악안면성형재건외과학회 1994 Maxillofacial Plastic Reconstructive Surgery Vol.15 No.4
The trauma has been known as a major etiologic factor in temporomadibular joint disorders The endotracheal intubation is suspected as one of the traumatic factor to temporomandibular disorder. But there are few reports about the amount of mouth opening during endotracheal intubation and temporomandibular joint disorder after endotracheal intubation. The authors studied the effects of endotracheal intubation to temporomandibular joint with 70 patients given surgical operation through general anesthesia The results were as follows. 1. The mean amount of mouth opening for entire patients during endotracheal intubation was 26.3mm(s, d: 2.6), for oral intubation group 25.9mm(s, d: 3.2), for nasal intubation group 26.6mm(s, d: 1.9). There was no difference between two group stastically. (p<0.05) 2. 1 week later endotracheal intubation, the maximum mouth opening increased 1.5mm for entire patients, 1.5mm for oral intubation group, 1.6mm for nasal intubation group than behare endotracheal intubation. 3. Five patients complained the discomforts around temporomandibular joint after endotracheal intubation. The amount of mouth opening during endotracheal intubation was within physiologic range. It seemed that 45° upward endoscopic lifting for exposure of glottis gave trauma to temporomandibular joint.
증례보고 : 지혈대 감압 후 라텍스 아나필락시스를 보인 환자의 마취 관리 -증례보고-
이진영 ( Jin Young Lee ),이현철 ( Hyun Chul Lee ),박윤정 ( Youn Jung Park ),정미화 ( Mi Hwa Jung ),최영룡 ( Young Ryong Choi ),원임수 ( Rim Soo Won ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Latex is the second most common cause of anaphylaxis during anesthesia. The increasing number of reports of latex-induced anaphylaxis are a major concern for anesthesiologists. We encountered a 56-year-old male patient who developed severe anaphylactic shock whilst under anesthesia when the tourniquet was deflated during elbow arthrolysis. A subsequent allergy workup revealed an IgE mediated hypersensitivity to latex. This case highlights the need for anesthesiologists to be able to diagnose the signs and symptoms of allergic reactions in patients under anesthesia. (Korean J Anesthesiol 2006; 50: 466~8)
임상연구 : 중화상 환자에서 Mivacurium의 신경근 약역학
정미화 ( Mi Hwa Chung ),정진경 ( Jin Kyung Jung ),이진영 ( Jin Young Lee ),곽인숙 ( In Suk Kwak ),최영룡 ( Young Ryong Choi ),원임수 ( Rim Soo Won ),한태형 ( Tae Hyung Han ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: Burned patients sometimes require rapid onset of neuromuscular paralysis to secure the airway in full stomach patients or to treat laryngospasm. Because of poor lung function and hypermetabolic state, they desaturate quite rapidly. Burned patients are usually resistant to the effects of nondepolarizing relaxants. Mivacurium can be potentially a good alternative for rapid onset of paralysis, since it is metabolized by plasma cholinesterase, an enzyme often decreased in subject with major burns. This prospective study was conducted to define the neuromuscular pharmacodynamic profile of a single bolus dose of mivacurium in adult patients with major burns. Methods: Adults (M/F = 22/8), aged 44.0 ± 10.2 years, with total body surface area (TBSA) burn of 35.0 ± 12.5% were studied at 39.8 ± 28.9 post burn days. Age and sex matched 30 non-burned patients served as controls. Anesthesia was consisted of propofol and fentanyl infusion with nitrous oxide and oxygen. Mivacurium 0.2 mg/kg was administered as a bolus. Using TOF Watch, neuromuscular block was monitored with T1 response after the initial tetanic stimulation to recruit all muscle fibers. Onset time was defined as the interval from the beginning of drug administration to maximal twitch suppression. Intubation was attempted at 1 minute after the drug administration to simulate the rapid sequence induction with recording of either failure or success of intubation. By allowing spontaneous recovery without reversal drug, recovery profiles of neuromuscular paralysis were also measured. Results: Patients demographics were similar in both groups except for the burn. Onset times and all recovery profiles were significantly prolonged in the burned versus non-burned groups. Attempts at intubation at 1 minute after the drug administration were successful with difficulty in approximately 70% of patients in both groups. Conclusions: Mivacurium 0.2 mg/kg demonstrated the conflicting dual responses in the burned patients. The prolonged onset time suggests resistance to neuromuscular effects. The prolonged recovery suggests increased sensitivity. This can be partially explained by the acetylcholine receptor proliferation and decreased level of plasma pseudocholinesterase. In view of the prolonged onset time of almost two minutes for maximal paralysis, mivacurium does not appear to be a good drug for rapid onset of paralysis in burns. (Korean J Anesthesiol 2006; 51: 541~6)
김지연 ( Ji Yeon Kim ),이우영 ( Woo Young Lee ),김정만 ( Jung Man Kim ),곽경진 ( Kyoung Jin Kwak ),전현아 ( Hyun Ah Jun ),김홍배 ( Hong Bae Kim ),이근영 ( Keun Young Lee ),강성원 ( Song Won Kang ),원임수 ( Rim Soo Won ) 대한주산의학회 2003 大韓周産醫學會雜誌 Vol.14 No.3
지방간 자체는 위험한 질병이 아니지만 임신 시 동반된 급성 지방간은 갑작스럽게 발생하고 산모 및 태아에게 치명적일 수 있다. 임신 중 급성 지방간은 임신 제 3분기에 나타나며 오심, 구토, 황달, 응고장애 등이 임상적인 특징이다. 이는 간 기능에 영향을 미칠 수 있는 자간전증, HELLP 증후군, 간염에 의한 전격성 간부전, 임신 중 간내 담즙 정체 등과 구별을 요하는데 임상적 특징과 혈액검사 그리고 합병증으로 구분이 가능하며 신속한 진단과 빠른 대처로 산모와 태아의 유병률과 사망률을 낮출 수 있다. 이에 저자들은 본원에서 경험한 임신 중 급성 지방간 1례를 문헌 고찰과 함께 보고하는 바이다. Acute fatty liver of pregnancy(AFLP) is rare, potentially fatal disorder developing in the third trimester of pregnancy. It is characterized by nausea, vomiting, jaundice and malaise. Initially the disease is often mistaken for preeclampsia, HELLP(hemolysis, elevated liver enzymes, low blood platelet count)syndrome, fulminant hepatitis and cholestasis of pregnancy. But acute fatty liver of pregnancy has clinical manifestations, biochemical findings and complications clearly distinguished of HELLP syndrome, fulminant hepatitis and cholestasis of pregnancy. We report a case of pregnancy complicated with fatty liver with brief review of the common causes of acute hepatic failure associated with pregnancy.